Provider Demographics
NPI:1306047972
Name:CARTY, LESLIE ANNE (DMD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ANNE
Last Name:CARTY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:2076 HWY. 51 NORTH
Mailing Address - City:WESSON
Mailing Address - State:MS
Mailing Address - Zip Code:39191-0069
Mailing Address - Country:US
Mailing Address - Phone:601-643-0026
Mailing Address - Fax:601-643-0530
Practice Address - Street 1:2076 HIGHWAY 51 NE
Practice Address - Street 2:
Practice Address - City:WESSON
Practice Address - State:MS
Practice Address - Zip Code:39191-6859
Practice Address - Country:US
Practice Address - Phone:601-643-0026
Practice Address - Fax:601-643-0530
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3123-001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660375Medicaid
MS551182OtherUNITED CONCORDIA